Within the history of poverty and its relief in eighteenth-century London, the parish nurse sits awkwardly between the workhouse (with its sick and lying in wards), on the one hand, and out-relief delivered in cash and in kind to the poor in their own homes, on the other. It is becoming increasingly apparent, however, that from at least the seventeenth century, and perhaps from a hundred years earlier, many parish nurses ran large and sophisticated businesses, that effectively operated in much the same way as the contract workhouses that developed from the the 1730s onwards. And, more than this, it is clear that, as a group, parish nurses were responsible for delivering a large proportion of parish relief.
At its most general, the role of nurse, including wet-nursing of infants, dry-nursing of children, and sick-nursing of adults, formed one of the most common female occupations in eighteenth-century London. On the basis of a large sample of deponents giving evidence to the London church courts, Peter Earle has estimated that upwards of 12 per cent of London women were employed in nursing in the first half of the eighteenth century; a figure only exceeded by domestic service (25 per cent) and the needle trades (18 per cent).1 The parish nurse, along with those working in hospitals, was likely to be the most secure and professional of the innumerable nurses plying their trade in London.
The slatternly, dirty and drunken parish or poor-law nurse became a stereotype in nineteenth-century literature. Charles Dickens' Sarah Gamp and Betsy Prigg are simply the best known of an army of fictional Florence Nightmares. But there is a more substantial basis than mere literary invention in the broader public perception of eighteenth-century nurses as uncaring and ineffective. In part, their unsavoury reputation was sealed by a series of high profile cases revolving around the care provided for the young. In 1693 Mary Compton was sentenced to death for the murder by starvation of four parish children in Poplar and was executed at Tyburn; and in 1718 Eleanor Gallimore, a nurse employed by St Andrew Holborn, stood trial on two occasions in a single year for murdering two separate infants left in her care. At her first trial, which resulted from the death of Richard Pugh at the age of ten months, she is described as frequently going out and leaving the five infants for whom she was responsible, "half a day together, and sometimes stay[ing] out all night a drinking, and use[d] the children cruelly; and ..., one evidence deposed she went in and found the child wrapped in a piece of an old rag and laid under the dresser...". Seven months later, she was tried again, this time for the death of Thomas Shaw, whom she was accused of murdering some three years earlier. She was acquitted on both occasions.
Throughout the century similar cases can be identified, with the conviction of Elizabeth Brownrigg for the murder of Mary Clifford, a parish apprentice, in 1766 forming the best known and most vigorously publicised story of parish children in danger.2
But as important was the use of parish nurses and their supposed inadequacies as a justification for change. In two pamphlets published in 1725 on behalf of the parishes of St Giles in the Fields and St James Westminster, the dubious role of the parish nurse was explicitly used to justify the creation of a workhouse:
And both Thomas Coram, in relation to the Foundling Hospital, and Jonas Hanway, in relation to his Acts of Parliament, cited the poor care provided by parish nurses as a social ill they were uniquely placed to help eradicate.
Complaints about nursing standards should not deflect us from the important role they played in delivering parish care. In a recent article charting the evolution of the system in the parish of St Martin in the Fields, Jeremy Boulton has described a sophisticated network of nurses, running houses that could accommodate tens of child and sick paupers. According to Boulton, in the fifteen years prior to the establishment of a workhouse in St Martin's in 1725, between 11 per cent and 18 per cent of all parish poor relief expenditure (between £457 and £842 per year) went to approximately nine individual nurses. Some nurses received upwards of two hundred and forty pounds a year in payment for the care of the poor. A large, but by no means the largest nursing home, run by a Nurse Pomfrett, for example, submitted ten bills in 1724/5 requesting payment under 273 different headings, itemizing the care of twenty-three individual paupers, and expecting £181 in payment. In effect, Nurse Pomfrett was running a long-stay nursing home on a scale equivalent to a small parish workhouse.4
Other parishes, such as St James Westminster and St Giles in the Fields, were similarly investing heavily in nursing care prior to the establishment of a workhouse. In a single year, St James Westminster spent £520 on nursing care for eighty sick paupers (12.8 per cent of total expenditure); while in St Giles in the Fields, the equivalent figures were £600 spent on seventy paupers (14.3 per cent). And to these figures could be added the £2,000 spent by the two parishes to support hundreds of dependant orphaned and deserted children.5
The system used in St Martin, St James and St Giles was radically reconfigured with the establishment of large parish workhouses in 1725, but other parishes, most notably those without workhouses, continued to use independent nurses throughout the century. St Clement Danes, one of the parishes whose records are included on this site, retained the services of a series of nurses for children throughout the century, and for adults until the creation of its own workhouse in 1773. Jonas Hanway used the example of one of the St Clement Danes' nurses, Hannah Poole, to exemplify the problems with the system as part of his campaign to ensure that parish children be cared for in the countryside.
Jonas Hanway was a master of rhetoric, and used the example of the death of eighteen out of some twenty- three children left in the care of Hannah Poole (or "Mrs. Nurse Poole", as he names her in print), evidenced from the 1766 Registers of Poor Children (RC) kept by parishes, to damn the system of parish nurses more generally. In part, Hanway was attempting to encourage Parliament to employ the Foundling Hospital as a general nursing provider for parish children - and in the process to retrieve the Hospital's financial position following the collapse of the General Reception - but in the process he effectively paints Hannah Poole as an angel of death, available for hire at 2s per week per child:
No doubt Hanway's assessment is correct in its essentials for 1766, but it gives us little sense of the nature of the service Hannah Poole provided, or the reasons why the death rate for infants in her care might be this high. The surrounding parish documentation, however, provides some answers.
An analysis of the equivalent register for two years later (1768), which unlike Hanway's statistics records children over four years old, gives an impression of the size and complexity of Poole's nursing home. Among the paupers housed at parish expense were twenty-six children aged fifteen or under. Most were long term residents of the house. Thomas Taylor had lived with Hannah Poole for eight years, since 1760, and was fifteen. John Smith and William Jones were also fifteen, and were apprenticed from the house after around a year's residence. Of the children accommodated, ten were between the ages of seven and fifteen; and a further thirteen were under the age of three. None of the older children are recorded as having died during the course of the year. Of these infants and toddlers, three did die, two of whom had been born in the house to mothers lying in at parish expense. A B by their names in the registers reflects their status as bastards. The third death was of an illegitimate child who came into Poole's care at eighteen months old. A fourth illegitimate child born in the house, Charlotte Sirr, died soon after being transferred to a country nurse. In this single year, there were are least three births in Hannah Poole's establishment. But more significantly, the bastardy examinations (EP) for the parish for the 1760s mention only one parish nurse as providing lying-in facilities for women giving birth at parish expense, and that one nurse was Hannah Poole.
In other words, Hannah Poole was providing care for a uniquely vulnerable group of babies (illegitimate children born to pauper mothers), and statistics reflecting their experience were then compared by Hanway to a very different group of children as part of an essentially misleading rhetorical device. In the case of the children in Poole's care, Hanway combined mortality rates for new-born infants, who were at the highest risk of death, with the rate for all children under the age of four. The statistics he uses for comparison, however, are very different. The Foundling Hospital, for instance, did not accept any children under a month old, and except during the General Reception, imposed a stringent health test on the infants it did accept, turning away any baby in a less than rosy condition. Hanway also lauded a Whitechapel nurse whose record of raising healthy children seems markedly at odds to Poole's dismal efforts, but unlike Hannah Poole, she only accepted children above the age of two.
Nor was Nurse Poole's care of children and lying in mothers the extent of her operation. Surviving Coroners' Inquests (IC) detailing two adult deaths at Mrs Poole's, one a suicide and the other the result of a drunken brawl in the street suffered by a women being treated by Poole for fever, also suggest that she provided a more general service to the parish, very much equivalent to a workhouse.
A substantial change in the role of parish nurses was wrought by the passage of Jonas Hanway's Act for the Better Regulation of the Parish Poor Children.7 It stipulated that all children below the age of four years should be nursed in the country at least three miles from London and Westminster (five miles in certain circumstances). To Hanway's disappointment, the ninety-seven parishes within the City of London were excluded from the provisions of the Act, as were four further urban parishes from Middlesex and Surrey, but the Act nevertheless ensured that a ring of nursing establishments grew up in a penumbra around London, as close as three miles from its centre. In part, this development built on the network of rural nurses employed by the Foundling Hospital, but it also encouraged the growth of ever larger and more lucrative operations that melded seamlessly into the contract workhouses serving the requirements of small City parishes. In the nineteenth century these institutions became the baby farms condemned by Victorian reformers, and damned by authors such as Charles Dickens in Oliver Twist.
Lives using the keywords Parish Nurse:
- Andrew, Donna T. Philanthropy and Police: London Charity in the Eighteenth Century. Princeton, 1989.
- Boulton, Jeremy. Welfare systems and the Parish Nurse in Early Modern London, 1650-1725. Family & Community History, 10:2 (2007), pp. 127-51.
- Honeyman, Katrina. Child Workers in England, 1780-1820: Parish Apprentices and the Making of the Early Industrial Labour Force. Aldershot, 2007.
- Levene, Alysa. Children, Childhood and the Workhouse: St Marylebone, 1769-1781. London Journal, 33:1 (2008), pp. 41-59.
- Murphy, Elaine. The Metropolitan Pauper Farms 1722-1834. London Journal, 27:1 (2002), pp. 1-18.
For further reading on this subject see the London Lives Bibliography.
1 Peter Earle, A City Full of People: Men and Women of London, 1650-1750 (1994), p. 116 ⇑
2 See Patty Seleski, Mistress, A Mother and A Murderess Too: Elizabeth Brownrigg and the Social Construction of the Eighteenth Century Mistress, in Katherine Kitredge, ed., Lewd and Notorious: Female Transgression in the Eighteenth Century (Ann Arbor, 2003); and Kristina Straub, The Tortured Apprentice: Sexual Monstrosity and the Suffering of Poor Children in the Brownrigg Murder Case, in Laura Rosenthal and Mita Choudhary, eds, Monstrous Dreams of Reason (2002), pp. 66-81. ⇑
3 Case of the Parish of St Giles in the Fields as to their Poor . ⇑
4 Jeremy Boulton, Welfare Systems and the Parish Nurse in Early Modern London, 1650-1725, Family & Community History, 10:2 (2007), pp. 127-51. See in particular, pp. 132-3. ⇑
5 Boulton, Welfare Systems and the Parish Nurse, p. 145. ⇑
6 Jonas Hanway, An Earnest Appeal to Mercy to the Children of the Poor (1766), p. 138 ⇑
7 7 George III c.39. ⇑